Coronary artery bypass with single versus multiple arterial grafts in women: A meta-analysis

Robinson, N. Bryce; Lia, Hillary; Rahouma, Mohamed; Audisio, Katia; Soletti, Giovanni; Demetres, Michelle; Leonard, Jeremy R.; Fremes, Stephen E.; Girardi, Leonard N.; Gaudino, Mario

doi:10.1016/j.jtcvs.2021.07.047

Cited by 12 publications

(8 citation statements)

References 28 publications

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“…Nonetheless, this outcome was sensitive to the small-study effect, demonstrating when we performed the leave-one-out sensitivity analysis. These results are in agreement with the outcomes of a previous meta-analysis by Robinson et al [ 61 ].…”

Section: Discussionsupporting

confidence: 93%

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses

Magouliotis

Fergadi

Zotos

et al. 2022

Gen Thorac Cardiovasc Surg

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Objective We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG). Methods Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA) and radial artery (RA) as a second arterial conduit was the secondary endpoint. Subgroup analyses were performed regarding patients older than 70 years, with diabetes mellitus, and females. A sensitivity analysis was performed with the leave-one-out method. Results Forty-four studies were included in the qualitative and thirty-nine in the quantitative synthesis. After pooling data from 180 to 459 patients, the MAG group demonstrated a higher OS (HR, 0.589; 95% CI, 0.58–0.60; p < 0.0001) and event-free OS compared with the SAG group (HR, 0.828; 95% CI, 0.80–0.86; p < 0.0001). In addition, RITA was associated with superior OS compared with RA as a second arterial conduit (HR, 0.936; 95% CI, 0.89–0.98; p = 0.009). MAG was also superior to SAG in patients over 70 years, females, and patients with diabetes mellitus. Sensitivity analysis demonstrated a small-size study effect on the female subgroup analysis. Conclusion The present meta-analysis indicates that MAG is associated with enhanced survival outcomes compared to SAG for patients undergoing isolated CABG.

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Section: Discussionsupporting

confidence: 93%

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses

Magouliotis

Fergadi

Zotos

et al. 2022

Gen Thorac Cardiovasc Surg

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“…However, the benefit of MAG in specific patient populations remains to be elucidated. In the few retrospective reports comparing MAG and SAG in women, MAG had significantly better outcomes compared to SAG [ 11 , 73 , 74 ]. In patients with diabetes, MAG was also associated with improved outcomes, although at the expense of a higher risk of deep sternal wound infection when BITA was used [ 75 ].…”

Section: Remaining Gaps and Questionsmentioning

confidence: 99%

Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting

Vervoort

Elbatarny

Rocha

et al. 2023

JCM

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Ischemic heart disease is the leading cause of morbidity and mortality worldwide and may require coronary revascularization when more severe or symptomatic. Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure and can be performed with different bypass conduits and anastomotic techniques. Saphenous vein grafts (SVGs) are the most frequently used conduits for CABG, in addition to the left internal thoracic artery. Outcomes with a single internal thoracic artery and SVGs are favorable, and the long-term patency of SVGs may be improved through novel harvesting techniques, preservation methods, and optimal medical therapy. However, increasing evidence points towards the superiority of arterial grafts, especially in the form of multiple arterial grafting (MAG). Nevertheless, the uptake of MAG remains limited and variable, both as a result of technical complexity and a scarcity of conclusive randomized controlled trial evidence. Here, we present an overview of CABG techniques, harvesting methods, and anastomosis types to achieve total arterial revascularization and adopt MAG. We further narratively summarize the available evidence for MAG versus single arterial grafting to date and highlight remaining gaps and questions that require further study to elucidate the role of MAG in CABG.

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“…CABG has been the preferred revascularization technique, especially for treating multi-vessel and complex coronary artery disease. Even though international guidelines and prevailing evidence advocate multiple arterial grafts (MAG) [ 5 , 6 , 7 , 8 ], contemporary surgical practice disproportionately utilizes the left internal mammary artery (LIMA) and supplementary saphenous vein grafts (SVG) [ 9 ]. The superior late clinical and angiographic outcomes of LIMA conduit have been well established [ 10 , 11 ], but only recently have radial artery (RA) outcomes been recognized to be superior [ 12 , 13 , 14 , 15 ] in comparison to SVG, which undergoes conduit atherosclerosis and progressive failure with 10-year occlusion rate of approximately 50% [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Survival of Multiple Versus Single Arterial Coronary Bypass Grafting in Elderly Patients

Ren

Royse

Srivastav

et al. 2023

JCM

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Multiple arterial grafting (MAG) utilizes more than one arterial graft with any additional grafts being saphenous vein grafts (SVG). It remains an infrequently used coronary surgical revascularization technique, especially in elderly patients. Our study aims to evaluate the age-related association with the relative outcomes of multiple versus single arterial grafting (SAG). The Australian and New Zealand national registry was used to identify adult patients undergoing primary isolated CABG with at least two grafts. Exclusion criteria included reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Propensity score matching was used to match patient groups. The primary outcome was all-cause late mortality and the secondary outcomes were 30-day mortality and 30-day hospital readmission. We selected 69,624 eligible patients with a mean (standard deviation) age of 65.0 (10.2) years old. Matching between MAG and SAG generated 16,882 pairs of patients < 70 years old and 10,921 pairs of patients ≥ 70 years old. At a median [interquartile range] follow-up duration of 5.9 [3.2–9.6] years, MAG was associated with significantly reduced mortality compared to SAG (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.68–0.78; p < 0.001) in the younger subgroup as well as the elderly subgroup (HR, 0.84; 95% CI, 0.79–0.88; p < 0.001). In conclusion, MAG offers a survival benefit over SAG, in both younger and elderly patients.

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Coronary artery bypass with single versus multiple arterial grafts in women: A meta-analysis

Cited by 12 publications

References 28 publications

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses

Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses

Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting

Long-Term Survival of Multiple Versus Single Arterial Coronary Bypass Grafting in Elderly Patients

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